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<meta charset="UTF-8">
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<link rel="stylesheet" href="css/util.css" />
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<title>医院信息完善</title>
</head>
<body>
<div class="content hos_msg_complete">
	<div class="navigate_head clearfix">
		<p class="" onclick="window.location.href='hos_group.html'">医院信息完善</p>
		<p class="navi_null"></p>
	</div>
	<div>
		<form class="add_role_form">
			<div class="public_input">
				<span><span>* </span>用户名:</span>
				<input type="text" class="role_name" placeholder="请输入英文字母、数字"/>
			</div>
			<div class="public_input">
				<span><span>* </span>设置密码:</span>
				<input type="text" class="role_describe" placeholder="长度为6-16位字符"/>
			</div>
			<div class="public_input">
				<span><span>* </span>确认密码:</span>
				<input type="text" class="role_describe" placeholder="请重新输入一次密码"/>
			</div>
			<div class="public_input">
				<span><span>*</span>医院名称:</span>
				<input type="text" class="data_base_name" placeholder="请重新输入正确的医院名称"/>
			</div>
			<div class="public_input">
				<span><span>* </span>医院地址:</span>
				<select class="data_base_name"style="width: 130px;">
					<option>省份</option>
				</select>
				<select class="data_base_name"style="width: 130px;">
					<option>地级市</option>
				</select>
				<select class="data_base_name"style="width: 130px;">
					<option>市、县级市</option>
				</select>
			</div>
			<div class="public_input">
				<span></span>
				<input type="text" class="data_base_name" placeholder="请输入医院的详细地址"/>
			</div>
			<div class="public_input">
				<span>医院等级:</span>
				<select>
					<option></option>
				</select>
			</div>
			<div class="public_input">
				<span>医院分类:</span>
				<select>
					<option></option>
				</select>
			</div>
			<div class="public_input">
				<span><span>* </span>医院的联系方式:</span>
				<input type="text" class="data_base_name" placeholder="请输入常用的联系号码"/>
			</div>
			<div class="public_input">
				<span><span>*</span>联系邮箱:</span>
				<input type="text" class="data_base_name" placeholder="请重新输入正确的医院名称"/>
			</div>
			<div class="public_input">
				<span><span>* </span>应急联系人:</span>
				<input type="text" class="data_base_name" placeholder="请重新输入正确的医院名称"/>
			</div>
			<div class="public_input">
				<span><span>* </span>应急联系人电话:</span>
				<input type="text" class="data_base_name" placeholder="请重新输入正确的医院名称"/>
			</div>
			<div class="public_input">
				<span><span>* </span>医院环境:</span>
				<input type="file" class="data_base_name" placeholder=""/>
			</div>
			<div class="public_input">
				<span><span>* </span>请点击阅读以下条款:</span>
				<input type="button" class="data_base_name" value="《e诺网服务条款》"/>
			</div>
			<div class="public_input confrim_btn">
				<span>.</span>
				<input type="button" class="confrim_add" value="提交"/>
			</div>
		</form>
	</div>
</div>
	
	
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